What is the organism causing RING WORM?
A patient presents with the following at your pharmacy. They ask for some Brolene eye drops. What do you do?
This is a subcojunctival haemorrhage
Ask them if it is painful- any pain then refer
Ask them if they are on WARFARIN- if yes seek medical attention ASAP
Have you had any injury to the eye recently?
If no to the above- reassure the patient that it is self limiting, usually better within 2 weeks and no OTC products are recommended
What kind of medication is Guaiphenesin?
These claim to make the coughing easier while enhancing production of mucus and phlegm.
Other example: Acetylcysteine, ammonium chloride
Not effective in children
What kind of medicine is Dextromethorphan?
Cough suppressant (antitussive)
What antihistamine do we usually give to children?
Suitable for 1 year and over
What age are steroid nasal sprays e.g. beconase, flixonase, not suitable in?
What drugs can be given on instalment prescriptions (FP10MDA) Other than Methadone?
Schedule 2 Controlled Drugs;
Buprenorphine/naloxone (Suboxone); and
How is payment for Instalment precriptions worked out?
Payment is based on each occasion the pharmacist provides an instalment to the patient; i.e. each time the patient collects their drug from the pharmacy
Pharmacy needs to fill out back of prescription each time the patient picks up an instalment
What formulations have more potential for abuse by addicts?
Syrup base less liable to abuse
Is it pharmacologically rational for a cough/cold remedy to contain dextromethorphan and guanefenesin? What about dextromethorphan and ammonium chloride?
Dextromethorphan is a cough suppressant so person coughing less
Guanefenesin and ammonium chloride both cough expectorants which means they make it easier to cough things up: work against eachother
What is the medication causing drowsniess usually included in cough/ cough rememdies to help people sleep?
A sedating antihistamine, found in things like Night nurse.
Also found in sleep aids such as sominex
What is cinnarazine and what is it used in?
characterized as an antihistamine and a calcium channel blocker
Used for travel sickness and vertigo and tinnitus (problems with inner ear)
Found in Stugeron- 2 tablets 2 hours before travel
If a specific brand is stated on a prescription (e.g. Losec capsules- Omeprazole) can you give the generic if you run out of the branded?
Must legally prescribe that brand unless you ask the prescriber to change the Rx to generic
What does sodium Citrate do to the pH of urine?
It increases the pH- makes urine more alkaline
Acidic urine in cystits- hence the burning feeling
Can pseudoephidrine cause drowsniess?
Can guaifenesin cause drowsiness?
Remember pseudoephidrine (SUDAFED) can be abused- stimulating- side effects include restlessness and insomnia, and hallucinations!
Guaifenesin does not cause drowsiness
Dextromethorphan can cause a little bit of drowsiness
Children under __ should not be given cough and cold medication OTC containing PSEUDOEPHEDRINE
Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.
Children under 6 years old
ANTITUSSIVES (suppressants) (DEXTROMETHORPHAN
Expectorants (GUAIFENESIN, ipecacuanha)
Nasal decongestants (pseudo, phenylephrine, ephedrine, oxymetazoline, xylometazoline)
Antihistamines: Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.
For use in 6-12 years they should be SECOND LINE and be used for no more than 5 DAYS
A patient with a productive cough for the last week requests a product containing dextromethorphan because they have heard good things. What do you do?
They may have requested Benylin Dry Cough
Similar product: Benadril Tickly Cough containing Pholcodine
These are cough SUPPRESSANTS
Should NOT suppress a productive cough- need to get the mucous out- so recommend an expectorant (Guaiphenesin)
It is recommened people include oily fish in their diet to help reduce CV risk. Can you think of any examples of these?
What is the organism causing athletes foot? How is athletes foot treated?
Topical imidazole (Miconazole) can be used- Apply twice daily and continue for 10 days after the lesions have healed
Bnf states under topical antifungals: to prevent relapse these should be continued for 1-2 weeks after healing
Could also consider Griseofulvin
Amorolfine (Curanail, Loceryl) can be used for fungal nail infections. What is the directions for this?
Apply 1-2 times a week for:
6 months for finger nails
9- 12 months for toe nails
Apply after filing and cleansing
BNF age limit: 12, OTC age limit: 18. 3 ml pack is a P
Why has the safety of using medicines containing codeine to treat coughs and colds in children younger than 18 been reviewed?
Because of the potential for serious problems like slowed or difficult breathing.
Children, especially those who already have breathing problems, may be more prone to these effects
Differences in metabolism of codeine: codeine is converted to Morphine in the body, this cause cause respiratory difficulties.
This use in under 18's only applies to codeine linctus for colds/ cough; codeine containing products for pain relief can still be used in > 12 years, sold to > 16 years.
What do we use to treat Oral thrush?
Topical Miconazole gel- Daktarin oromucosal gel
(Nystatin 2nd line, Fluconazole 3rd line if topical preps can't be used/ patient has a dry mouth)
What is Lyme disease caused by? What does the rash present as?
Caused by bacterial infection from Tick bites
An early symptom of this condition is a characteristic "bulls eye on a dartboard" rash (called erythema migrans) that isn't itchy
Usually treated with Doxycycline, amoxicillin or cefuroxime for 2-4 weeks
Is sunlight a good cure for cold sores?
Sunlight can trigger cold sores so direct sunlight should be avoided and sun screen should be applied.
How many days of co-codamol 30/500mg tablets could you give maximum as an emergency supply?
5 days max
As co-codamol contains codeine 30mg which is a schedule 5 CD!
Orlistat impaires the absorption of Fat soluble vitamins. Which are the Fat soluble vitamins?
Water soluble: B, C
Can GTN be bought OTC?
Both sub-lingual tablets and spray are P medicines
NB: Their effects last for 20-30 minutes, but in an emergency situation, repeat dose after 5 mins if no relief.
Can nursing homes bring their waste medicines to your pharmacy to dispose of?
Can the public: what will you do with the waste?
No- must use their own waste disposal
Only the public can bring it to the pharmacy: this is an essential service for the pharmacy to act as a collection point for waste medicines: sort it into solids, liquids and ampoules and arrange for waste contractor to pick it up.
Must not store waste for longer than 6 months, or over 5 cubic meters
What does 'Freshly prepared' mean?
What does 'Recently prepared' mean?
Freshly prepared: 24 HOUR EXPIRY
Recently prepared: 28 day expiry
What is information governance? How often do community pharmacies need to provide IG assurances to the NHS?
Does the Information Governance lead need to be a pharmacist?
IG is all to do with confidentiality and how to handle patient sensitive data.
Pharmacies need to submit IG assurances annually.
The lead does not need to be pharmacist but needs enough authority to make changes in information handling
Pseudoephidrine is contra-indicated in which condition?
What about phenylephrine?
Pseudoephedrine: Hypertension, coronary artery disease, MAOI's in the last two weeks
Phenylephrine: diabetes (as may increase glucose) and CV disease
Eye drops containing a lubricant only (e.g. propylene glycol) will expire in _____
Co-amoxiclav oral suspension will have an expiry of ____ once it is made up
Most eye drops will have an expiry of _____. What expiry do chloramphenicol eye drops have, considering they contain an antibiotic?
still 28 days for chloramphenicol- it it just reduced to 14 days on wards at slam. Patients are still advised to discard the drops 5 days after opening (after finishing the course)
Oramorph 20 mg/mL solution- schedule? Expiry?
Schedule 2 CD
Anything over 2.6mg/ml (13mg/5ml) is schedule 2
4 month expiry
The lower strength (2mg/ml) has a 3 month expiry
Which emollient does not contain Urea?
The mainstay of treatment OTC of travel sickness involves antihistamines:
Promethazine: Promethazine Hydrochloride (Phenergan) and Promethazine Teoclate (avomine)
Which one of these has a 24 hour duration of action?
Which one causes most sedation?
Which is the most effective for the prevention of motion sickness?
24 hour duration: Promethazine Teoclate
Most drowsiness: Promethazine Hydrochloride (Phenergan)
Most effective: Hyoscine hydrobromide
What are the likely side effects of the antihistamines/ anticholinergics used in travel sickness?
be careful with other medication that can cause sedation: alcohol, TCA's, opioids
Which travel sickness medication would be most appropriate for a young child, 4 years old?
Hyoscine hydrobromide (licesned for over 3 years [joy rides]) or meclozine for over 2 years
How does plaque psoriasis present?
Silvery white scales, when scraped away pinpoint bleeding occurs from the capillaries
What is the only contact lense solution that can be applied whilst contact lenses are still in the eye?
If a patient has recently had their tonsills out (tonsillectomy) or adrenal glands out (adrenectomy) what OTC drug is cautioned?
If they have sleep apnoea (i.e. find it hard to breathe at night) then CODEINE is cautioned as can cause respiratory problems which can be fatal (Fatal ADRs reported)
What presents as the following image accompanied by sore throat, headache, high temperature?
Antibiotics needed- refer
With treatment, most people recover in about four to five days and can return to school 24 hours after starting antibiotic treatment. Without treatment, you'll be contagious for one to two weeks after symptoms appear.
Where should Latanoprost eye drops be stored?
In the fridge
Where does the new inhaler, Fostair Nexthaler, containing steroid Beclometasone and LABA formoterol, need to be stored?
At room temp
Its the old fostair (inhalation solution) that needs to be kept in a fridge
Which eye drops used in glaucoma can cause a change in eye colour?
What do the yellow and what do the pink Migraleve tablets contain, and what is the max of each to be taken in 24 hours?
Pink: Paracetamol, codeiene, Buclizine
Yellow: Paracetamol, codeine
Max in 24 hours: 2 pink + 6 yellow
What is a buldging spot on a babies forehead accompanied by vomiting, fever, cold hands likely to indicate?
early signs of meningitis- refer to A and E!
What are the signs and symptoms of Otitis externa?
Oedematous (fluid build up) leading to conductive hearing loss
Ear canal/ external ear are red, swollen and eczema like
What does treatment of Otitis externa involve?
ACETIC ACID (earcalm spray)- one spray to the affected ear TDS, max frequency 2-3 hours, continue for 2 days after symptoms gone
Choline salicylate drops- Earex Plus
Referral symptoms for ear conditions? (Considering Otitis Externa and Ear wax are the only ones that can be treated OTC!- Need to rule out otitis media- infection of inner ear)
Mucopurulent discharge (pus)- otitis media
Pain on palpitation of the mastoid area
Generalised inflammataion of the pinna
Impaired hearing in a CHILD
Slow-growing growths in elderly
Symptoms present over 4 days
What are simeticone drops indicated for?
Infant colic- excessive, frequent crying in a baby
One week trial of simeticone drops recommended: drops are designed to help release bubbles of trapped air in your baby's digestive system.
How is allergic rhinitis differentiated from the common cold? What are reatment options OTC for this?
Allergic rhinitis presents as: sneezing, rhinorrhoea and nasal itching
Loratidine- 1st line
2nd line: Sodium cromoglicate nasal drops (but take 1-2 weeks to work)- a mast cell stabiliser
Or steroid nasal spray (over 18's)
Azelastine- the only nasally administered antihistamine OTC
Can you get monoxidil on NHS prescription?
If patients are using several topical agents, when should the emolient be applied?
How often can emollients be applied?
Before.... Leave at least 5 mins between applying to allow absorption.
emollients contain no active so can be applied as many times.. but general guidance is 2-3 times a day.
We say that stimulant laxative are not first line constipation remedies, however when may we chose to recommend it?
If someone has been constipated for a while e.g. 10 days (refer if over 14 days) as these work quickly (6-12 hours) so may be appropriate for one-off use.
Can Gaviscon be used in pregnant women suffering from gastro-oesophagul reflux ?
Yes: remember your acronym APPLE: A= Antacids
Acid reflux is common in preganancy when the baby gets larger towards the end: they respond well to Alginate products like Gaviscon- can take through the day and night
If a patient using Benzoyl Peroxide experiences drying, burning or peeling of the face, should they stop using the product?
Just advise reducing the frequency of administration- stop using for a day or two then reduce to OD or use on alternate days
We know codeine should be avoided for pain in children 12-18 years where possible. Who would you chose to give codeine to out of a 24 year old ethiopian man and a 31 year old Norweigan man?
The norweigan man
African/ ethiopian and middle eastern people are more likely to be ultra-rapid metabolisers of codeine so do not give to these patients.
What condition presents with a rash, white coating of the tongue, plus headache and fever leading up to it?